Project Summary/Abstract This goal of this project is to refine and pilot test a flexible PrEP Retention (PrEP-R) intervention that leverages organic social support network members of HIV-negative young Black men who have sex with men (YBMSM) to improve retention in PrEP care. While data exist for YBMSM on PrEP linkage, receipt, and adherence, there is a lack of empirically tested interventions on a key intermediate step: retention in PrEP care. Several existing strategies seek to address challenges to retention in HIV care, including case management, peer health navigation, and multi-modal programs. These efforts all rely on newly created network members, a traditional public health approach. What is often missing in these strategies is a coordinated attempt to harness organic social support networks. Our use of ?organic? refers to a naturally existing social support network, which is distinct from newly generated support persons, e.g., assigned peer navigators or case managers. The concept of organic social support as a powerful force in the health of HIV infected persons is well documented, but has been underutilized to retain YBMSM in PrEP care. However, sexual minorities are often stigmatized and need persistent, deep, and ongoing social support, the kind that is often only available from existing confidants? friends, kin, and other persons?with whom one might share personal information and be influenced by. Flexibility of PrEP-R ensures that a support confidant (SC) is selected based on factors such as providing a supportive function (e.g., emotional support) as opposed to their status (e.g., mother). Such SCs are likely important not only to retention in PrEP care, but also to sustained health maintenance, risk reduction behavior maintenance and long-term adherence to PrEP. We have developed a brief, theoretically-grounded, culturally- sensitive PrEP-R intervention that (1) utilizes social support network visualization and network theory to help YBMSM safely identify a SC to engage in retention in PrEP care activities; (2) uses an Information-Motivation- Behavioral Skills Model targeted at the SC to activate and maintain PrEP-specific social support in the dyad; and (3) a linked PrEP-specific social support conceptual model to then drive appointment adherence among index YBMSM. Our primary aims are to: (1) Refine PrEP-R intervention protocol, materials and assessments by (1) shifting more of the intervention to focus on the SC through individual and dyadic sessions; and (2) developing a systematic procedure to generate social support of the client by engaging the SC via mini-booster cell phone sessions; and (2) Pilot test the feasibility (reach, adoption, and implementation) and initial efficacy (number of 3-month periods with 1 completed visit) of the PrEP-R intervention versus standard linkage to care at 12-months post randomization among a sample of 160 YBMSM ages 18-29. Secondary outcomes to be assessed include self-efficacy, social support, HIV/STI testing frequency and maintenance of health insurance. Secondary outcomes include self-efficacy, social support, HIV/STI testing frequency, and health insurance maintenance. This pilot study will provide objective data in support of our next step: an adequately powered RCT testing the effectiveness of PrEP-R to promote retention in PrEP primary care versus treatment as usual.